CCRN CARDIAC REVIEW EXAM
S3 - answer-Rush of blood into dilated ventricle
Associated w/ HF, pulm HTN, cor pulmonale, mitral/aortic/tricuspid
insufficiency
S4 - answer-Atrial contraction of blood into noncompliant ventricle (so will
not hear w/ Atrial Fibrillation, d/t no atrial contraction)
Associated w/ myocardial ischemia, infarction, HTN, ventricular hypertrophy,
aortic stenosis
Pain on deep inspiration - answer-Pericardial friction rub d/t pericarditis
Cardiac arteries perfused during: - answer-Diastole
SBP = indirect measure of... - answer-Cardiac Output (CO) and Stroke
Volume (SV)
DBP = indirect measure of... - answer-Systematic Vascular Resistance (SVR)
Acute MI Murmur at Apex - answer-Papillary muscle dysfunction or rupture
(rupture is emergency)
Acute MI Murmur at Sternal Border (5th ICS) - answer-Ventricular septal
defect
Stable Angina - answer-Chest pain w/ activity
Unstable angina - answer-Chest pain AT REST
Troponin NEGATIVE
ST depression, T-wave inversions
Treat w/ NTG (nitroglycerin)
NSTEMI - answer-Troponin POSITIVE
ST depression, T-wave inversion
Women and diabetics might not have chest pain w/ MI
STEMI - answer-Troponin POSITIVE
ST ELEVATION IN 2+ LEADS
Women and diabetics might not have chest pain w/ MI
Variant/Printzmetal's Angina - answer-Chest pain AT REST (can by cyclic -
same time each day)
D/t coronary artery spasm
Troponin negative
, ST ELEVATION
REVERSIBLE - treat w/ NTG
Acute Chest Pain 1st Action = - answer-EKG w/in 10 min
Chest Pain Treatment - answer--ASAP Aspirin chew
-Anticoagulant = heparin, enoxaparin
-Antiplatelet = Clopidogrel (Plavix), Abciximab (Reopro), Eptifibatide
(Integrilin), Tirofiban (Aggrastat)
-Cardioselective Beta Blocker (unless COCAINE involved) = Metoprolol (NOT
propranolol); CONTRAINDICATIONS = hypotension, bradycardia, Viagra or
other phosphodiesterase-inhibitors
-Pain = NTG/Morphine
Lead Changes in II, III, aVF - answer-Right Coronary Artery (RCA), Inferior LV
Lead Changes in V1, V2, V3, V4 - answer-Left Anterior Descending (LAD),
Anterior LV
Lead Changes in V5, V6, I, aVL - answer-Circumflex, Lateral LV
Lead Changes in V5, V6 - answer-Low Lateral LV
Lead Changes in I, aVL - answer-High Lateral LV
Lead Changes in V1, V2 - answer-RCA, Posterior LV
Lead Changes in V3R, V4R - answer-RCA, Right Ventricular (RV) Infarct
STEMI Treatment - answer-If <12 hrs of chest pain = REPERFUSION
PCI for STEMI - answer-90 min door to balloon inflation
Re-occlusion = chest pain, ST elevation
Sheath Removal = potential vasovagal (SBP<90 w/o tachycardia,
pallor/nausea/yawning/diaphoresis), treatment = atropine (0.5mg IV) then
fluids
Retroperitoneal Bleeding = sudden hypotension, severe low back pain (give
fluids, blood products)
Stent Thrombosis = check pulses
Fibrinolytic Therapy for STEMI - answer-Contraindications = bleeding risk
Evidence of Reperfusion = chest pain, resolution of ST changes, elevation of
troponin, arrhythmias
Assess for bleeding, reperfusion, re-occlusion
NSTEMI Treatment - answer-NO emergent reperfusion
